Provider Demographics
NPI:1528207008
Name:VASQUEZ, AILYN MIRANDA (PT)
Entity Type:Individual
Prefix:
First Name:AILYN
Middle Name:MIRANDA
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AILYN
Other - Middle Name:TRINIDAD
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:87 BELLS OF IRELAND CT
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34446-5815
Mailing Address - Country:US
Mailing Address - Phone:443-839-6349
Mailing Address - Fax:
Practice Address - Street 1:87 BELLS OF IRELAND CT
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34446-5815
Practice Address - Country:US
Practice Address - Phone:443-839-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24490225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist